NHS England confirms how it will measure same-day urgent GP access target
NHS England has confirmed how it will measure a new requirement for GP practices to ‘deal with’ all clinically urgent requests on the same day.
In new guidance published today, the commissioner said that practices should record appointments for ‘all patients they deem to be clinically urgent’ using appointment slots mapped to the ‘general consultation acute’ category within General Practice Appointments Data (GPAD).
From 1 April, GP practices will be contractually required to ‘deal with’ all clinically urgent patient requests on the same day, and at the beginning of the month NHS England said it was developing a method of measuring how practices are performing against the requirement.
The guidance set out how practices should use national category appointment slots and NHS England’s ‘approach to measuring target’.
It said that data on the proportion of clinically urgent appointments undertaken the same day will be made publicly available through a change to the existing GPAD collection, and that ICBs will ‘monitor and support’ practices to achieve the requirement.
The guidance said: ‘Moving forward, practices should record appointments for all patients they deem to be clinically urgent using appointment slots mapped to the General Consultation Acute national category within General Practice Appointments Data (GPAD). This applies to patients presenting by telephone, walk-in or online.
‘It is for the GP practice to determine which patients are clinically urgent, in the same way they do now.
‘The decision about whether a patient is clinically urgent does not need to be a retrospective clinical judgement, but rather a decision made based on the patient’s presenting complaint.’
NHS England said that performance against the target will be calculated in the following way each month, via the ‘general consultation acute’ GPAD category:
- Numerator = number of appointments mapped to a national category of ‘general consultation acute’ which took place on the same day (time from booking to appointment)
- Denominator = total number of appointments mapped to a national category of ‘general consultation acute’
Action for practices
- Prioritise a review of appointment book slots for clinically urgent activity, ensuring that the slot is mapped in line with the national category guidance.
- Review all other appointment book slots to check alignment between slot mapping and the national category guidance. There may be some clinically urgent activity captured within these slots without the practice being aware.
- Review appointment book slot mapping against the proposed categories to be used for ‘non-clinically urgent’
- Review individual GPAD dashboards which will help in identifying any potential issues unique to the practice.
Source: NHS England
The commissioner also said that to ‘support understanding of demand’ in general practice, it will collect data on the percentage of ‘non-clinically urgent’ appointments taking place within 7 and 14 days
It added: ‘Practices should be aware that for the purposes of this we are intending to use the national categories of General Consultation Routine and Care Home Visit.
‘At this point we are not intending to include Unplanned Clinical Activity, Walk-in, and Home Visit categories given these can be either urgent or routine, and each comprises less than 1% of total activity.’
As for what will happen to practices that miss the target, NHS England’s contract letter last week told practices they will be mandated to ‘engage’ with ICBs to reduce ‘unwarranted variation’ from 1 April.
It said this would include ‘where practices are not meeting their requirement to see all clinically urgent patients on the same day or are at risk of contractual breach’.
The Government had put forward a proposal for an ‘access incentive scheme’ – seemingly linking its ‘ambition’ for 90% of patients to be seen on the same day to financial repercussions – but, following the contract consultation, decided not to go through with it due to resistance from stakeholders.
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READERS' COMMENTS [7]
Please note, only GPs are permitted to add comments to articles
There is another way to measure this, Dr Doyle will be delighted to learn.
Measure the height of all patients who get urgent appointments and divide by the number of patients. This will give the mean “urgency coefficient of value/m”, c. Then divide the number of patients seen urgently by the number of urgent appointments requested, to get the gross marginal efficiency. Multiply that by the coefficient c. And you get the net marginal efficiency per metre of patient-lump.
Calculate monthly for all practice GPs to get comparative totals (also useful for benchmarking…and to identify GPs for the chop).
Use differential calculus to identify incremental variations for optimisation of urgent access. Employ multivariate regression tools to look for patterns in differences between practices which may be due to age, gender, race etc profiles. Expand model to other categories eg Care Home Visits…
Await shrieking and grunting as wild-eyed herds of GPs shamble and stampede to the exit….
This is absurd micromanaging and simply will be yet another reason for those GP’s that able to leave the NHS.
NHS General Practice is going the way of NHS dentistry.
Performance management has spectacularly failed with secondary and community care and is the only language that DH NHSE understand.
The unintended consequences of their actions.
It cannot have escaped Wes Streeting’s notice as many as four in 10 patients on long waiting lists choose to access and fund their own private care.
Patients getting frustrated & wanting to go private is not an unintended consequence, It is intended consequence. politicians have realised that NHS in current format is not sustainable & want to make it so bad that people would voluntarily want NHS collapsed so politicians can’t be blamed. Clever moves in last few years
The Socialist Calculation Problem was described in the last millennium. The technocrat class is a natural consequence of socialism and its beliefs that wise administrators can plan for the best of the citizens if they are given the right tools and techniques to make the hard decisions that they are brave enough to make.
These are the tactics of Rogue Capitalism. Not socialism. To suggest otherwise is naive or dissimulation.
For over 50 years now, sociable capitalism has increasingly given way to Extreme Neoliberal financialisation (see 2008 crash).
This Pulse article describes the sort of policies being conjured up under this Fanatical capitalist regime – the use of Macchiavellian tactics to destroy the fabric of public goods (like the metricisation described, and false marketisation of the NHS, schools etc).
It’s not social nor Socialism but it is, however, deeply Antisocial. A form of Capitalism that’s gone rogue on its Road to Serfdom via “creative destruction” – that Schumpeter foresaw (but to which Mises, Hayek and Friedman were blind).
Disciples of neoliberalism in both Tory and New Labour Govts have had their day. The evidence of their Extreme Antisocial Capitalism is all around us in the broken landscape.
This absurd scheme scores a 9.7 on the Doyle Index
‘Our pilot study conducted on behalf of the CQC concludes that all practices will be required to be above average’ – Prof. Ima Bellcurve, University of Silly Ideas. London